Program Operations Manual System (POMS)

A. Introduction

Totalization coding is used to generate notice language in claims for U.S. benefits
(Totalization or nonTotalization) and to produce an earnings record to be sent to
the foreign country with a claim for foreign benefits. In addition, since entitlement
to a Totalization benefit cannot establish entitlement to premium-free hospital insurance
(HI) under Medicare (see GN 01701.140), the presence of some codes prevents automatic
HI enrollment. The Social Security Administration has developed a series of Totalization
codes to indicate on the Master Beneficiary Record (MBR) the status of a claim for
U.S. Totalization benefits and the name of the agreement country involved.

B. Process

Totalization codes are posted to the MBR only when there is a claim for U.S. Totalization
benefits. The coding is systems generated based on entries on the modernized claims
system (MCS) screens. Claims for benefits from a foreign country do not generate any
codes or indicators. However, the Division of International Operations (DIO) will
annotate the Modernized Development Worksheet (MDW) screen when a claim for benefits
is forwarded to the foreign country.

C. Definitions

1. Totalization Status Codes (TSC)

TSCs are two digit codes that describe the status of a claim for U.S. Totalization
benefits. The different codes are defined below.

a. Award Codes

Codes

Definition

A1

Number holder (NH) is insured only by combining U.S. and foreign coverage.

A3

NH is insured only by combining U.S. and foreign coverage and the beneficiary is entitled
to premium-free HI as a Medicare Qualified Government Employee or an End Stage Renal
Disease beneficiary.

E2

NH was initially insured only by combining U.S. and foreign coverage, subsequently
acquired enough additional U.S. credits to be insured based on U.S. coverage alone
but continues entitlement to Totalization benefits because they are greater (see GN 01701.305B.1.).

b. Denial codes

NH has at least 6 QCs but is not insured even after counting foreign coverage.

D3

NH is insured based on U.S. coverage alone.

D4

NH is insured based on U.S. coverage alone or by combining U.S. and foreign coverage
but does not meet another entitlement factor (e.g., age).

c. Claim pending codes

Codes

Definition

P1

NH has at least 6 QCs but is not insured and the claim cannot be adjudicated until
the foreign coverage record is received.

P2

A nonTotalization claim has been awarded but Totalization may yield an earlier month
of entitlement or disability insured status.

d. Termination codes

Code

Definition

T1

Totalization benefits have terminated because the beneficiary became entitled to higher
nonTotalization benefits.

2. Totalization Country Codes (TCC)

TCCs are 5 character alpha codes that identify, by country, the agreement under which
a claim for U.S. Totalization benefits has been filed. Where an applicant has filed
under more than one agreement, only one code will be shown. These codes are defined
below.